Summary & Overview
CPT 12019: Simple Repair of Superficial Facial Wounds, 2.6-7.5 cm
CPT code 12019 is a nationally recognized billing code for the simple repair of superficial wounds on the face and related areas, covering wounds between 2.6 cm and 7.5 cm. This code is significant for clinicians in dermatology, surgery, family medicine, general practice, and emergency medicine, as it standardizes reimbursement and documentation for a common office-based procedure. Blue Cross Blue Shield is a key payer included in this analysis, reflecting widespread coverage for this service.
Readers will gain insight into the clinical context of 12019, including its typical use in office settings and its relevance for treating lacerations without foreign bodies. The publication also covers related codes for wound repair and dehiscence, common modifiers used in billing, and associated taxonomies. Policy updates and benchmarks are discussed to provide a comprehensive overview of how this code is utilized across specialties. This summary is designed to inform healthcare professionals, billing specialists, and policy analysts about the current landscape for simple wound repair procedures.
CPT Code Overview
CPT code 12019 describes the simple repair of superficial wounds on the face, ears, eyelids, nose, lips, and/or mucous membranes, specifically for wounds measuring between 2.6 cm and 7.5 cm. This procedure is commonly performed in the field of dermatology and is typically provided in an office setting (Place of Service 11). The code is used to document and bill for straightforward wound closures that do not require layered or complex repair techniques.
Clinical & Coding Specifications
Clinical Context
A patient presents to a dermatology office with a superficial laceration on the face, such as the nose or lip, measuring between 2.6 cm and 7.5 cm. The wound is clean, without foreign bodies, and requires a simple repair. The provider assesses the injury, ensures there is no deeper tissue involvement, and performs a simple closure using sutures or adhesive strips. The procedure is typically performed in an office setting (Place of Service 11) and may involve documentation of the wound's size, location, and the method of closure. The clinical workflow includes wound assessment, cleaning, anesthesia if needed, closure, and post-procedure instructions.
Coding Specifications
-
Modifier
59: Used to indicate a distinct procedural service when multiple procedures are performed that are not normally reported together, but are appropriate in the clinical scenario. -
Modifier
51: Used to denote multiple procedures performed during the same session by the same provider, allowing for proper reimbursement and documentation.
| Modifier Code | Description |
|---|---|
59 | Distinct Procedural Service |
51 | Multiple Procedures |
- Provider Taxonomies:
| Taxonomy Code | Specialty |
|---|---|
207ND0900X | Dermatology |
208600000X | Surgery |
207Q00000X | Family Medicine |
208D00000X | General Practice |
207P00000X | Emergency Medicine |
These taxonomies represent the specialties commonly performing simple wound repairs in office or emergency settings.
Related Diagnoses
-
S01.81XA: Laceration without foreign body of other part of head, initial encounter- Relevant for wounds on the head not specifically covered by other codes; matches the anatomical scope of
12019.
- Relevant for wounds on the head not specifically covered by other codes; matches the anatomical scope of
-
S01.01XA: Laceration without foreign body of scalp, initial encounter- Used when the laceration is located on the scalp; may be repaired with
12019if within the size range.
- Used when the laceration is located on the scalp; may be repaired with
-
S01.111A: Laceration without foreign body of right eyelid and periocular area, initial encounter- Pertains to lacerations of the eyelid and surrounding area; aligns with the anatomical sites listed in
12019.
- Pertains to lacerations of the eyelid and surrounding area; aligns with the anatomical sites listed in
-
S01.211A: Laceration without foreign body of nose, initial encounter- Used for nasal lacerations; directly relevant to the procedure described by
12019.
- Used for nasal lacerations; directly relevant to the procedure described by
-
S01.411A: Laceration without foreign body of lip, initial encounter- Applies to lacerations of the lip; matches the anatomical scope for simple repair with
12019.
- Applies to lacerations of the lip; matches the anatomical scope for simple repair with
Each diagnosis code represents a clinical scenario where a superficial laceration, without foreign body, is present and requires simple repair as described by 12019.
Related CPT Codes
-
12011: Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less- Used for smaller wounds in the same anatomical regions; often an alternative to
12019for wounds under 2.5 cm.
- Used for smaller wounds in the same anatomical regions; often an alternative to
-
12020: Treatment of superficial wound dehiscence; simple closure- Used when a previously repaired wound has reopened and requires simple closure.
-
12021: Treatment of superficial wound dehiscence; with packing- Used for wound dehiscence requiring packing, rather than simple closure.
-
12031: Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); 2.5 cm or less- Used for intermediate repairs in different anatomical regions; not typically used with
12019but may be relevant in multi-site injuries.
- Used for intermediate repairs in different anatomical regions; not typically used with
-
13131: Repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; 1.1 cm to 2.5 cm- Used for complex repairs in similar regions; may be an alternative when the wound requires layered closure or is more involved than a simple repair.
Codes 12011, 12020, and 12021 are commonly used as alternatives or in conjunction with 12019 depending on wound size and clinical scenario. Codes 12031 and 13131 are used for more complex or intermediate repairs in other anatomical regions.
National Reimbursement Benchmarks
For CPT code 12019, Blue Cross Blue Shield and BUCA (average commercial) both report a national mean rate of $80.02. Medicare data is not available in the input, so a comparison between commercial and Medicare rates cannot be made.
Rate dispersion across both Blue Cross Blue Shield and BUCA is minimal, with the 25th, 50th, and 75th percentiles all at $80.00. This indicates a very tight range, suggesting little variation in reimbursement rates among providers nationally for these payers.
The table and chart below present the full breakdown of national mean rates and percentile values for each payer.
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.